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Monday, February 15, 2010

Race and Insanity?

Many of us are familiar with mental illness because these afflictions are so common they can strike our closest family members. Certainly, one of the most misunderstood mental illnesses is schizophrenia, which many mistakenly believe is "split personality" — it's not. Psychiatrist Jonathan Metzel, has written a provocative book that relates our recent discussions of race, discrimination, and perception to this particular mental illness.

In an interview embedded below, he argues that before the 1960s, schizophrenia was "a disease of docility", predominately affecting white women. But during the Civil Rights Movement, all that changed, especially in the media, movies and prescription drug ads.

But the key change was in the DSM-II, the handbook psychiatrists utilized to diagnose mental illnesses. Specifically, words like "hostility" and "aggression" were added to the definition of paranoid schizophrenia. And guess what? The actual diagnosis of schizophrenic African-American men climbed suddenly.

Since then, those words have been taken out of the latest edition of the DSM, but research has shown that schizophrenia had been over-diagnosed in African-American men ever since.

Think again about our class discussion on "invisible" factors and institutional racism. What conclusions can you draw now?

5 comments:

Howard Zinn talks about this "acceptable" kind of prejudice in his Declarations of Independence. Thoughtful discernment is a necessary skill we all have to develop and practice constantly, whether watching television, a movie or reading a book.

I found it very informative when Jonathan Metzel stated, "the DSM is a cultural document and it reflects its cultural environment as much as anything else". It makes sense that during the 1960's, at the height of the Civil Rights movement and active African American protesting, that suddenly these words would be added. Perhaps the psychiatrists during this time, which I am presuming to be dominantly white (considering the limited opportunities for blacks), constructed the new diagnosis based off their feelings of African American protests.

Once the new definition was formed, it apparently permanently assimilated into our culture. This might eplain why African-American men have been overdiagnosed ever since. The DSM not only reflects a cultural environment but the environment reflects the DSM, which is what was discussed during the description of the media and the "chicken or the egg" segment of the talk. Even though the definition changed and 'hostility' and 'aggression' are no longer visible, a diagnosis might still be perceived that way.

It's really interesting how the image of African-Americans changed during the civil rights movement. During slavery, blacks were portrayed as docile, happy, and dumb, with characters like Sambo and the "comic" use blackface in Minstrel shows. But once African Americans started to challenge society's norms of inequality/segregation, they were no longer depicted as docile, but were instead perceived as aggressive/hostile, and as that was associated with mental disorder, it could have been used to dismiss the validity of African American activists' actions as merely being the result of mental abnormality/instablity.

The switch in definitions for schizophrenia reminds me of female hysteria during the Victorian era, a time period in which there were very strict roles for men and women (ex. not allowing women to be intellectual). It was originally considered to be exclusively a women's illness, but is now no longer even considered a legitimate disorder. One of the most interesting symptoms of the 75+ possible (they had very little knowledge of medicine, so basically anything could make a woman a 'hysteric') was "a tendency to cause trouble." For both hysteria and schizophrenia (and leprosy, and PTSD) the acceptable definitions and perceptions of such disorders reflect and depend on the political and social values of the time, even despite what may be scientifically accurate. And for both disorders, anyone perceived to be pushing the envelope had a higher chance of being perceived as mentally unsound. And some of these beliefs may still affect us even after we seem to move on (with African Americans remaining overdiagnosed, remaining perception of PTSD as weakness, and perpetuated myths about leprosy.)

I think that it is not only our perceptions of mental illness, but also our perceptions of 'backwardness.' In class some students voiced the opinion that, on average, black society praised loud protests over formulaic letters of displeasure. Now I don't think that this is true, but if many whites (who are often in charge of things like what goes in the DSM) see loud blacks as 'the other,' it seems likely that they, consciously or not, would look to remove that threat.

Of course, if blacks are angry, they have reason to. We see pictures like of blacks yelling in the street, but that is how you get heard. Racist white men could easily send rioters to insane asylums. It seems unlikely that it was an organized conspiracy (I trust my country too much) but it is very possible that this was done subconsciously.

“Objectivity is impossible,” Zinn once remarked, “and it is also undesirable. That is, if it were possible it would be undesirable, because if you have any kind of a social aim, if you think history should serve society in some way; should serve the progress of the human race; should serve justice in some way, then it requires that you make your selection on the basis of what you think will advance causes of humanity.”

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